COPD in primary care: Towards simple prediction of quality of life, exacerbations and mortality

We found that previous health-related quality of life (HRQL) was the best predictor in our models to predict COPD-specific HRQL in primary care COPD patients. Asking patients explicitly about dyspnoea, fatigue, depression and how they cope with COPD provides additional important information about future HRQL while FEV1 or other commonly used predictors add little to the prediction of HRQL. Depending on the outcome per HRQL-domain, GPs and patients can discuss and prioritize different possible treatment actions in a shared decision-making context.
We found that simple tests for measuring exercise capacity, such as the one-minute sit-to-stand-test and the handgrip test, are strongly associated with mortality, significantly associated with HRQL and not associated with exacerbations. Since more complicated tests, such as the six-minute-walking-test, are usually not available in primary care settings, these simple tests could be an attractive alternative.
With regard to measuring physical activity, we found that the practical LAPAQ was unsuitable for measurement of physical activity in older adults in comparison with a triaxial accelerometer. However, it may be used to determine if a person's level of physical activity is above the recommended level.
With regard to measuring exacerbations, we found that the common way of measuring exacerbations by patient's self-report appears to be only moderately accurate, when compared to central event adjudication by a committee. The misclassifications involved could lead to considerable underestimation of treatment effects. Therefore, these committees could also considerably reduce sample size requirements and cost of randomised controlled trials and observational studies.